Strengthening Devotion: A Classic Grounded Theory on Acceptance, Adaptability, and Reclaiming Self, by Parents of Children with Autism Spectrum Disorders...

Ramona Rolle-Berg, Ph.D., HTCP, MS, CPGL Kara Vander Linden, EdD, MS, BA Abstract The experiences of parents rearing an autistic child(ren) framed an exploration of caregiver well-being using Glaser’s classic grounded theory.  The theory delineates struggles, stress, and self-growth through service.  Viewed as a roadmap, strengthening devotion guides caregivers through a fear-driven landscape of altered perceptions that fuels evolution in awarenss about what it means to love nonjudgmentally with unqualified faith not only in a child(ren) but in one’s own resilience. Acceptance, adaptation, and a reclaiming of relinguished self-focus define strengthening devotion.  In accepting, entrapment wanes as emotions signal reengagement; in adapting, self-esteem develops with emotion regulation; and in reclaiming life, resilience signals reimagining of self. As uncertainty and reactivity are delimited through activities of service, devotion evolves, conceptualized as a stage-dependent growth continuum, namely: Strengthening Parental Devotion, Strengthening Relational Devotion, and Strengthening Personal Devotion.  Ultimately, parents may use the strengthening devotion roadmap to corroborate where they have been, how far they have traveled, and chart proactively to lower stress, improve health outcomes and re-engage with life’s unlimited potential. Keywords:  caregiver, autism spectrum disorders, devotion, classic grounded theory, parenting, presence Introduction One in 45 US children exhibits behaviours representative of autism spectrum disorders (ASD) (Zablotsky, Black, Maenner, Schieve, & Blumberg, 2015).  These behaviours produce post-traumatic-stress syndrome-conditioned reactivity in parent caregivers.  This research offers caregivers a pathway to thrive rather than survive on the frontlines of daily caregiving. Glaser’s classic grounded theory (CGT) method provided the systematic structure through which Strengthening Devotion emerged as a roadmap for parent caregivers’ experiences of self-growth through service.  The Basic Social Process (Bigus, Glaser, & Hadden, 1982; Glaser, 1978) that arose is grounded in data, conceptualizing experiences of parent caregivers for wellness professionals engaged with this population. Source data integrated 33 items, including first-person published accounts in books, web pages, blogs, and direct interviews of parent caregivers responding to the grand tour question: “Tell me about your experience as a caregiver.” Method The purpose was to develop a theory to explain and to categorize the experiences of parents who provided caregiving to their children with ASD. Varied perspectives were sought. Classic grounded theory was used to analyze data systematically. Discovery of underlying patterns of behavior that might lead to escalating levels of abstraction and conceptualization was the goal (Glaser, 1978). Participants were adults 21 years of age and older, who are parents and primary caregivers for a child with ASD and adults identified through theoretical sampling prepared to share experiences of caregiving for a child.  Years of caregiving ranged from a minimum of eight to a maximum of several decades.  Study participants were also single or married and provided caregiving in situations that included neurotypical children and multiple children with ASD families. Establishing the boundaries of the emergent theory required interviews with participants outside the primary study group (e.g., caregivers of neurotypical children). Recorded participant experiences were transcribed into digital data and then underwent considerable and deliberate fragmentation through conceptual coding, the core CGT process (Holton, 2007).  Constant comparison of incident with incident, and incident with concept, etc., initially generated substantive descriptors and later theoretical categories (Glaser, 1992).  Incidents were identified line-by-line within the empirical data and then assigned a code.  Codes were grouped and compared when patterns or variations on patterns were recognized. Two types of CGT coding procedures were utilized: substantive coding, which collectively comprise open and selective coding, and theoretical coding.  Open coding supported the early work with the raw data. ...

Self-Balancing Sanctuarying: A Classic Grounded Theory of Relaxation...

Ruth Tiffany Naylor, CPsychol, British Autogenic Society, Ltd., London, England Abstract This author aimed to set out a grounded theory (GT) of relaxation as it is carried out under the normal pressures and tensions of everyday life. After switching from using the Corbin and Strauss grounded theory (2008) design to classic grounded theory, the author discovered a five-step theoretical causal-consequence model emerged from the analysis of what 21 non-anxious-to-slightly-anxious people from the community said what they do to relax. Their main concern is self-balancing. A disturbed sense of ease (cause) arising from internal and external threats (context) leads to resolution by switching (core category) in safety (condition). The chosen switching activities are self-emergent. Their continuing use depends upon transforming hindrances and integrating feedback to the process to maximize benefits (contingencies and consequences). Three switching strategies are central. Benefits not consciously or analytically generated are restoring, refreshing, and re-energizing me; maintaining and building me; and growing and developing me. Restoring, refreshing, and re-energising me is characterized by a sense of well-being and lifted mood; maintaining and building me is characterized by integrating and strengthening the core self and connecting to the community; growing and developing me is characterized by expanding self-discovery. Theoretically situating extant descriptive and conceptual models of relaxation is one of the many contributions this research makes. Keywords: anxiety, classic grounded theory, relaxation, positive psychology, interacting cognitive subsystems model. Introduction Prior to this research, relaxation has been viewed as a process of letting go of all tension not only in the body, in the sense of micro-factors of muscle physics and electrical activity (Jacobson, 1964), but also of macro-factors of such as those arising in the environment (Selye, 1946), the mind, and the spirit (Benson, 1975). The debate about psychophysiological relaxation that took place in terms of Claude Bernard’s abstract concept of the constancy of the milieu intérieur (Modell, et al., 2015) and which was made more concrete and practical by Cannon (1932) and then by Selye is now taking place in terms of allostatic balance, load, and overload (Chuang, Glei, Goldman, & Weinstein, 2007). This historic focus on release of muscle tension was driven by a mechanistic medical view of how humans “work.” This means that active relaxation activities have rarely been studied together with passive ones, and that neither have been studied in the context of life as lived. Theoretically, while relaxation is mentioned in related disciplines which do include contextualised activities involving significant body movements, such as in Csikszentmihayli’s extensive empirical, conceptual, and theoretical work on “flow” in work and play (1975), the largest body of recent empirical work directly focusing on relaxation, per se, is Smith’s (1990, 1999) which focuses on passive relaxation activities. Smith (1990) developed a set of structured inventories using factor analysis of words and phrases culled from passive relaxation therapy text books. These questionnaires were then used to develop “R[elaxation]-State” concepts which are said to be emotional, mental, and physical states. Smith (1990) first hypothesized a hierarchical linear model of how people progress through the R-States and later a “dual path” (Smith, 1999, p. 45) model, with the suggestion that any sequence through the R-States may be possible. As mindfulness took hold in the United States, the dual-path model has been re-framed in a mindfulness context and re-named “window of renewal” (Smith, 2007, p. 41). ”Core mindfulness” and “transcendence” were then hypothesized to be anchoring concepts in the new conceptual model, which focuses on the activity itself and not on...

Rolling with the Punches: Clinician Resistance in a Managerial NHS Hospital...

Mogamat Reederwan Craayenstein, University of the Witwatersrand, South Africa. Teresa Carmichael, University of the Witwatersrand, South Africa. Awaatief Musson-Craayenstein, University of the Witwatersrand, South Africa. Abstract The substantive area explored in this article is hospital consultants in an English Acute NHS hospital dealing routinely with increasing managerialism. Data were drawn from 49 interviews with hospital consultants, at one English Acute NHS hospital Trust. The classic grounded theory named “Rolling with the Punches” that emerged was enriched by literature relating to everyday resistance, labour process theory, institutional complexity and organisation studies by considering public and private (internal) scripts. Interpretation of the emergent theory also drew from everyday resistance narratives from rural peasantry applied to the highly qualified public sector hospital professionals. The theory reiterates the role of discursive resistance in the workplace. Keywords: hospital, managerialism, resistance, NHS, workplace, resistance, professional, doctor Introduction The National Health Service, NHS in the United Kingdom has come into its own as crown jewel of the public services. What happens in the NHS affects the entire UK. For the past 30 years, the NHS has experienced radical changes in its organisation structures and managerial regimes (Ackroyd & Thompson, 2003b; Thompson & Ackroyd, 1995). Healthcare delivery has been transformed with metrics-based performance management, electronic monitoring (Farrell & Morris, 2003), and enhanced audit and accountability (Ferlie, McGivern, & FitzGerald, 2012). Work intensity increased. Changes in the modes of control have resulted in shifting power relations between non-clinical managers and clinicians, especially hospital consultants. There is a lack of understanding about how clinicians and non-clinical managers routinely interact (Kuhlmann et al., 2013b). These changes mean that professional agency within a managerial context should be clarified (Correia, 2013; Muzio, Brock, & Suddaby, 2013). Dissatisfaction is evident (Dickinson, Ham, Snelling, & Spurgeon, 2013; Exworthy et al., 2010; Morris & Farrell, 2007; Spyridonidis & Calnan, 2011); however, the repertoires of dissatisfaction in such a context are not well-studied (Reay & Hinings, 2009) (Bélanger & Edwards, 2013), highlighting an opportunity for exploration. This study goes beyond a simple binary of non-clinical managers versus hospital consultants. It shows that the responses of doctors are socially constructed, situated, complex and complicit. Managerial initiatives shape, constrain and stimulate clinical practice in non-hegemonic ways and doctors find spaces to evade managerial control (Ackroyd & Thompson, 2016).  Clinicians do not have grand visions of resistance, but they do whatever they can, as bricoleurs (Levi-Strauss, 2004), using the tensions between structures that constrain and those that enable (Giddens, 1984). This study illuminates the routine responses of doctors as they encounter managerialism in their clinical practice in an acute hospital setting. Methodology: Classic Grounded Theory The researchers followed classic grounded theory procedures during data collection, coding, and analysis. The emergent grounded theory and its constructs were the basis of the literature review that followed. We conducted 49 interviews that were recorded in mind-map format and written up as field notes immediately after the interview. Audio recording and transcription were deemed unnecessary (Glaser, 1998), and the participants were unwilling to be recorded for fear that the recordings, with their recognisable voices, may fall in the wrong hands. In addition to the interviews, 20 observation encounters were captured, also in mind-map format. These observation sessions allowed the researchers to view the participants going about their everyday work within the research context (Barley & Kunda, 2001; Zilber, 2002). The observation sessions were those of a “complete” (or detached) observer (Burgess, 2006). Documentary evidence from the Trust website and other relevant NHS bodies...

Positioning: A classic Grounded theory on nurse researchers employed in clinical practice research positions...

Connie Berthelsen, RN, MSN, PHD, Aarhus University, Denmark Abstract The purpose of this classic grounded theory was to discover the general pattern of behavior of nurse researchers employed in clinical hospital research positions. Internationally, efforts have been made to strengthen evidence-based practice by hiring more nurses with a PhD for research positions in clinical practice. However, these nurse researchers are often left to define their own roles. I used data from a Danish anthology of six nurse researchers’ experiences of being employed in clinical hospital research positions. The theory of Positioning emerged as the general behavior of the nurse researchers, involving seven interconnected actions of building an identity and transformations of self, which varied in intensity and range of performance. Positioning characterized nurse researchers’ actions of following and connecting two paths of working as a postdoctoral researcher in clinical practice and moving towards a career in research, both guided by their personal indicators. Keywords: nurse researchers, grounded theory, positioning, clinical hospital research, building an identity Introduction Traditionally, nurses with a PhD degree are employed at Universities, where they educate nurses in scientific and academic programs, supervise PhD students, and conduct research (Orton, Andersson, Wallin, Forsman, & Eldh, 2019). However, times are changing and the paths into hospital positions are steadily growing worldwide for nurses with PhD degrees. In Denmark, we see an increase in nurses with a PhD in clinical hospital settings, where they are employed in academic positions such as clinical nurse specialists, postdoctoral researchers, senior researchers and clinical professors (Berthelsen & Hølge-Hazelton, 2018a). However, academic nurses holding Master’s degrees are also finding their way into hospital and primary care settings as clinical nurse specialists, advanced practice nurses, and PhD students. Due to the low level of evidence-based practice in nursing, academic nurses are needed as role models and leaders of research and development in clinical practice (van Oostveen, Goedhart, Francke, & Vermeulen, 2017; Orton et al., 2019). Even though nurse researchers, holding PhD and/or Master’s degrees, are multiplying in clinical practice, their roles and specific tasks are somewhat ambiguous, which can create insecurity and confusion about how to perform at their best (Berthelsen & Hølge-Hazelton, 2018c ). This aspect was seen in an intrinsic single case study of nurse researchers in clinical hospital positions, where the main theme of being “Caught between a rock and a hard place” identified the nurse researchers’ experiences of being in clinical practice in hybrid roles, feeling that they did not fit in anywhere (Berthelsen & Hølge-Hazelton, 2018c ). The nurse leaders play a particularly important role in the integration of nurse researchers in clinical practice, as they can help to create and support the optimal environment for research in the department (Bianchi et al., 2018). Data from a Danish anthology of six nurse researchers’ narratives about being employed in clinical hospital research positions were used in an attempt to discover the actions, processes, and behaviors of nurse researchers in clinical practice (Hølge-Hazelton & Thomsen, 2018). The aim of this study was to generate a classic grounded theory on the general pattern of behavior of nurse researchers employed in clinical hospital research positions. The research question that guided the study was: What are nurse researchers’ main concern in their clinical hospital research positions and how do they resolve it? Methods Classic grounded theory, based on Barney G. Glaser’s (1978, 1992, 1998) methodology, was chosen in order to discover a substantive theory on the general pattern of behavior of nurse researchers employed in...

Editorial

Astrid Gynnild Editor I am delighted to introduce the first issue of the Grounded Theory Review as an open access journal. This means that from now on, all academic articles provided by the journal are freely accessible online, including the archives. As an interdisciplinary, peer reviewed methodological journal, the Grounded Theory Review serves a broad academic community across continents. We are committed to the worldwide dissemination and advancement of classic grounded theory methodology, and similar to an increasing number of academic journals, we support a free exchange of scholarly knowledge, independent of access to scholarly funding or library facilities. We are convinced that the switch to open access will benefit not only readers but also the authors, who will see their articles more widely read and cited. That being said, it is important to emphasize that open access only concerns audience’ access to scholarly knowledge. As a peer reviewed journal we adhere to the highest standards of scholarly publishing and will constantly work on quality improvement. As such we will strive for a prompt turnaround on reviews; returning reviews to authors as quickly as is consistent with a thorough evaluation of their work. As the new editor of the Review, I am grateful to the former editor-in-chief, Judith Holton and the dedication she has shown over the last eight years. Judith has developed the journal to a high scholarly level, not the least through systematic quality improvement of the peer review process. I also wish to thank Cheri Fernandez, who has served as an assistant editor of the journal since 2010 and who is the guest editor of the themed section of this issue. On assuming my role as editor, I was delighted to learn of her well developed plans for an issue on constructivist grounded theory. I am also grateful to Carol Roderick for her continued and valued contributions as copy editor. Thanks to Scot Hacker, Helen Scott, and Shimrit Berman, who all did great work with the new journal web site. This issue starts with a general section, which deals with two topics that are of concern to all researchers who plan to use grounded theory. I am happy to publish the first chapter in Barney G. Glaser’s coming book Stop, Write! Writing Grounded Theory, in which dr. Glaser discusses writing blocks and how we can develop our sensitivity for the readiness moment for writing. The second article, written by Lorraine Andrews et al., discusses how grounded theory can be used to analyze secondary data. In the themed section, guest editor Cheri Fernandez has collected four articles that deal with the differences between classic grounded theory and constructivist grounded theory. The collection includes an introduction to constructivism written by Tom Andrews, an exemplar of constructivist grounded theory written by Dori Barnett; a commentary to Barnett’s article by Tom Andrews and Cheri Fernandez; and a reprint of Barney G. Glaser’s article from 2002, Constructivist Grounded Theory? Jenna P. Breckenridge et al. close this section with “Choosing a Methodological Path: Reflections on the Constructivist Turn.” For the coming issues of the Grounded Theory Review, we are interested in grounded theories and methodological papers as well as papers on teaching and learning grounded theory, and shorter conceptual discussions (see submissions)....